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Multidetector CT evaluation of the course of nonresectable pancreatic carcinomas with neoadjuvant therapy. Pancreatology 2009; 9:621-30. [PMID: 19657217 DOI: 10.1159/000212096] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 08/07/2008] [Indexed: 12/11/2022]
Abstract
OBJECTIVE A prospective study to determine the value of multidetector CT (MD-CT) in assessing the course of nonresectable pancreatic carcinoma during therapy. MATERIAL AND METHODS 26 patients with nonresectable pancreatic carcinoma underwent MD-CT before and after therapy. The examinations were evaluated with regard to tumor size and vascular invasion using an invasion score (IS) by 2 radiologists independently (kappa analysis). Diagnosis was confirmed surgically, by biopsy or clinical course. RESULTS Sensitivity for the assessment of irresectability was 100%. Following therapy, 54% of all the tumors were smaller (14/26), 42% had increased in volume (11/26), and one tumor remained stable (1/26). The IS (veins) during follow-up changed in 26 patients (portal vein: 5 higher (mean score 10.4/16.2), 4 lower (mean score 17.5/11.5); superior mesenteric vein: 12 higher (11/14.4), 5 lower (16.2/14.6); p = 0.026). The IS (arteries) changed in 13 patients (celiac trunk: 3 higher (3.3/10); hepatic artery: 4 higher (5.7/10.2), 3 lower (11.6/10.3); superior mesenteric artery: 2 higher (4.5/9.5), 1 lower (12/11)). The kappa values were calculated between 0.56 and 0.87. CONCLUSION MD-CT is suitable for evaluating tumor spread during therapy for nonresectable pancreatic carcinoma. The IS is useful for assessing the degree of change in vessel invasion.
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[MR imaging in cardiac amyloidosis--morphology, function and late enhancement]. ROFO-FORTSCHR RONTG 2008; 180:639-45. [PMID: 18561066 DOI: 10.1055/s-2008-1027337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Since limited data is available using MR imaging in cardiac amyloidosis, the purpose of our study was to evaluate morphological and functional differences of the heart using cardiac MRI. MATERIALS AND METHODS 19 consecutive patients (14 males, 5 females, mean age 59 +/- 6 years) with histologically proven cardiac amyloidosis were evaluated with MRI at 1.5 T. Results were compared with data of 10 healthy, age-matched control subjects (5 males, 5 females, mean age 60 +/- 6 years). Functional and morphological data including late enhancement (LE) was acquired. RESULTS Compared to the control group, patients with cardiac amyloidosis had thickened atrial walls and dilated atriums. Both ventricles and the interventricular septum were thickened. The LV hypertrophy was focal in 11 / 19 (58 %) and global in 4 / 19 (21 %) of patients. A myocardial edema occurred in 2 / 19 patients with cardiac amyloidosis (11 %). An edema of the myocardium was visible in 2 / 19 (11 %) of patients. The LV ejection fraction was statistically significantly decreased. The prevalence of LE was 74 % (14 / 19 of patients). LE was detected predominantly in the LV anterior wall and in the interventricular septum. Within the segments LE was located predominantly in a subendocardial location. Between patients with and without LE no statistically significant differences of functional and morphological results were able to be established. CONCLUSION There are three major outcomes of our assessment: 1. The LV hypertrophy is focal in the majority of patients with cardiac amyloidosis. 2. No statistically significant differences can be established in regard to the functional and morphological features between patients with and without LE. 3. Myocardial edema is a possible feature in cardiac amyloidosis.
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[A radiological case collection with interactive character as a new element in the education of medical students]. ROFO-FORTSCHR RONTG 2008; 180:337-44. [PMID: 18499910 DOI: 10.1055/s-2008-1027217] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Evaluation of an interactive, multimedia case-based learning platform for the radiological education of medical students. MATERIALS AND METHODS An interactive electronic learning platform for the education of medical students was built in HTML format independent of the operating system in the context of the Heidelberg Curriculum Medicinale (HeiCuMed). A case collection of 30 common and authentic clinical cases is used as the central theme and clinical background. The user has to work on each case by making decisions regarding a selection of diagnostic modalities and by analyzing the chosen studies. After a reasonable selection and sequence of diagnostic radiological modalities and their interpretation, a diagnosis has to be made. An extensive collection of normal findings for any modality is available for the user as a reference in correlation with the pathology at anytime within each case. The case collection consists of 2053 files with 1109 Internet pages (HTML) and 869 image files (.jpeg) with approximately 10 000 crosslinks (links). The case collection was evaluated by a questionnaire (scale 1 - 5) at the end of the radiological student course. The development of the results of the radiological course exam was analyzed to investigate any effect on the learning performance after the case collection was introduced. RESULTS 97.6 % of the course participants would use the case collection beyond the radiological student course to learn radiology in their medical studies. The handling of the case collection was rated excellent in 36.9 %, good in 54.6 %, satisfactory in 8 % and unsatisfactory in 0.4 %. 41 % felt that the case collection was overall excellent, 49.2 % good, 7.8 % satisfactory, 1.6 % unsatisfactory and 0.4 % poor. A positive trend in the development of the results in the radiological course exam with less variance after the introduction of the case collection was found but failed statistical significance. CONCLUSION A platform-independent, interactive, multimedia learning platform with authentic clinical cases and multiple choice elements for the user is the ideal method for supporting and expanding medical education in radiology. The usefulness and the reasonable exertion of diagnostic modalities are conveyed in a practical context as teaching goals. The high acceptance among students is based on the interactivity and use of multimedia.
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A new invasion score for determining the resectability of pancreatic carcinomas with contrast-enhanced multidetector computed tomography. Pancreatology 2008; 8:204-10. [PMID: 18434758 DOI: 10.1159/000128557] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 01/15/2008] [Indexed: 12/11/2022]
Abstract
OBJECTIVE It was the aim of this study to evaluate a new infiltration score to determine the resectability of pancreatic carcinomas in preoperative planning. MATERIALS AND METHODS Eighty patients with suspected pancreatic tumor were examined prospectively using 16-row spiral CT. The scans were evaluated for the presence of pancreatic carcinoma, peripancreatic tumor extension and vascular invasion using a standardized questionnaire. Invasion of the surgically relevant vessels was evaluated using a new invasion score. The operative and histological findings and the clinical follow-up served as the gold standard. RESULTS Forty patients had a pancreatic carcinoma, 5 had metastasis of a different primary tumor, and in 35 patients, there was no malignant pancreatic disease. The sensitivity for tumor detection was 100%, with a specificity of 88% for differentiating between malignant and benign pancreatic tumors. Invasion of the surrounding vessels was evaluated correctly using the invasion score, with a sensitivity of 89% and a specificity of 99%. In evaluation of resectability, a sensitivity of 94% and a specificity of 89% were achieved. CONCLUSION Using 16-row spiral CT, the invasion score is a valid tool for correctly assessing invasion in relevant vessels in cases of pancreatic carcinoma and for determining resectability.
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CT and endoscopic ultrasound in comparison to endoluminal MRI: preliminary results in staging gastric carcinoma. Eur J Radiol 2008; 70:336-41. [PMID: 18337043 DOI: 10.1016/j.ejrad.2008.01.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Revised: 12/17/2007] [Accepted: 01/22/2008] [Indexed: 01/03/2023]
Abstract
PURPOSE To prospectively compare diagnostic parameters of a newly developed endoluminal MRI (endo-MRI) concept with endoscopic ultrasound (EUS) and hydro-computer tomography (Hydro-CT) in T-staging of gastric carcinoma on one patient collective. MATERIAL AND METHODS 28 consecutive patients (11 females, 17 males, age range 46-87 years, median 67 years) referred for surgery due to a gastric malignancy were included. Preoperative staging by EUS was performed in 14 cases and by Hydro-CT in 14 cases within a time frame of 2 weeks. Ex vivo endo-MRI examination of gastric specimens was performed directly after gastrectomy within a time interval of 2-3h. EUS data were acquired from the clinical setting whereas Hydro-CT and endo-MRI data were evaluated in blinded fashion by two experienced radiologists and one surgeon well experienced in EUS on gastric carcinomas. RESULTS Histopathology resulted in 4 pT1, 17 pT2, 3 pT3 and 2 pT4 carcinomas with 2 gastric lymphomas which were excluded. Overall accuracy for endo-MRI was 75% for T-Staging of the 26 carcinomas. EUS achieved 42.9% accuracy; endo-MRI in this subgroup was accurate in 71.4%. Hydro-CT was correct in 28.6%, accuracy for endo-MRI in this subgroup was 71.4%. CONCLUSION The direct comparison of all three modalities on one patient collective shows that endo-MRI is able to achieve adequate staging results in comparison with clinically accepted methods like EUS and Hydro-CT in classifying the extent of tumor invasion into the gastric wall. However the comparison is limited as we compared in vivo routine clinical data with experimental ex vivo data. Future investigations need to show if the potential of endo-MRI can be transferred into a clinical in vivo setting.
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Efficacy and safety of percutaneous transhepatic portal embolization before right liver resection using an ethibloc/lipiodol mixture: a single-center experience. Dig Surg 2008; 25:52-9. [PMID: 18303266 DOI: 10.1159/000118795] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Accepted: 11/04/2007] [Indexed: 12/14/2022]
Abstract
AIM The purpose of this study was to evaluate the safety and efficacy of percutaneous transhepatic portal vein embolization of the right portal vein with an Ethibloc/Lipiodol mixture to induce hypertrophy of the left liver lobe in patients with primarily unresectable liver tumor. METHODS 15 patients (8 primary liver tumors, 7 liver metastases) underwent portal vein embolization. Liver volumetry, duration of hospitalization, complication rates, relevant laboratory values were documented. RESULTS In 13/15 patients (84.6%) embolization could be performed with a median of 8.8 ml (range 1.5-28 ml) Ethibloc/Lipiodol. One minor procedure-related complication (subcapsular hematoma) occurred, which did not affect the two-step liver resection. No patient developed acute liver failure after embolization or liver resection. The volume of the left liver lobe increased significantly (p = 0.0015) by 25% from a median of 750 ml (587-1,114 ml) to 967 ml (597-1,249 ml). 11/13 (81.8%) of the embolized patients underwent liver resection at a median of 49 days after embolization. Median hospitalization time was 4 days after embolization and 7 days after liver resection. Median overall survival of the 11 operated patients was 376 days. CONCLUSION Percutaneous transhepatic portal vein embolization using an Ethibloc/Lipiodol mixture is a safe, feasible, and efficient interventional procedure.
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Nachhaltige Schmerzreduktion durch Kyphoplastie bei Patienten mit osteoporotischen Wirbelkörperfrakturen: 3-Jahres Follow-up in einer prospektiven kontrollierten Studie. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Zystische Echinokokkose – Hohe Sensitivität und Spezifität der Magnetresonanztomographie (MRT) bei der Detektion zystobiliärer Fisteln. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Die Rolle der Bildgebung (MDCT und Angiographie) und der radiologischen Intervention (Embolisation) bei Diagnose und Therapie des akut blutenden Patienten. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ein neuer Infiltrationsscores für die Resektabilitätsbeurteilung von Pankreaskarzinomen mit der Multidetektor-CT. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Charakterisierung der Membranbewegung bei Patienten mit chronischer B-Dissektion mittels EKG-getriggerter CT. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Quantitative Molekulare Ultraschallbildgebung zur Erfassung der Expression angiogener Markermoleküle in Plattenepithel-Xenografts unter Therapie. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Morphologie von Desmoiden bei FAP (familiäre adenomatöse Polyposis) unter Therapie anhand der Magnetresonanztomographie. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
PURPOSE The purpose of this study was to evaluate the clinical long-term success of uterine artery embolization (UAE) in patients with symptomatic fibroids using spherical particles (Embosphere). MATERIALS AND METHODS 34 consecutive patients treated with UAE were initially enrolled in the study which had the following study goals 1) 1-year follow-up MRI evaluation of the fibroid behavior and 2) clinical long-term success due to standardized assessment of the main fibroid-related symptoms (hypermenorrhoea, dysmenorrhoea and dysuria) of the patients' individual overall health status and their therapy satisfaction at 1-year, 2- year and 3-year intervals after UAE. RESULTS Technical success was achieved in all procedures. Four patients had to be excluded from the long-term evaluation schedule: one because of a hysterectomy due to bleeding after 6 weeks, 3 patients were not available for the designated minimum follow-up interval. The preinterventional severe hypermenorrhoea (n = 27) with a score of 4.4 +/- 0.7 (5 = extreme menstrual bleeding) decreased after one year to 2.1 +/- 0.5 (p = 0.0001), after two years to 1.7 +/- 0.5 (p = 0.0042) and after three years to 1.3 +/- 0.6 (p = 0.0001). The preinterventional dysmenorrhoea (n = 15) with a score of 3.1 +/- 1.5 (3 = distinctly increased dysmenorrhoea) decreased after one year to 1.1 +/- 0.3 (p = 0.0001), after two years to 1.2 +/- 0.2 and after three years to 1.2 +/- 0.4 (p = 0.148). The pretreatment dysuria (n = 12) with a preinterventional score of 3.1 +/- 1.5 (3 = distinctly increased dysuria) decreased after one year to 1.1 +/- 0.3 (p = 0.0069) and remained after two years at 1.1 +/- 0.2 and after three years at 1.2 +/- 0.4 (p = 0.905). The initial overall health status was 54.7 +/- 20.1 (maximal value 100). After one year it rised to 90.5 +/- 15.4 (p = 0.0001), was 91.8 +/- 5.6 after two years and was 91.3 +/- 8.5 (p = 0.8578) after three years. The satisfaction with the therapy was 2.9 +/- 0.2 after one year, 2.6 +/- 0.3 after two years and 2.7 +/- 0.5 (3 = extremely satisfied) after three years. We observed 12 minor and 3 major complications (one hysterectomy, one fibroid expulsion associated with a short bleeding episode and one transient amenorrhoea for three months). All patients benefited clinically from the procedure and a clinical benefit was achieved in all cases. CONCLUSION Under controlled study conditions, flow-guided UAE with spherical embolization particles achieves high clinical success for all relevant clinical symptoms without negative changes during follow-up after at least 3 years. Accordingly, patient therapy satisfaction remained extraordinarily high even 3 years after UAE.
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Experimental Evaluation of Early and Long-Term Effects of Microparticle Embolization in Two Different Mini-Pig Models. Part I: Kidney. Cardiovasc Intervent Radiol 2007; 30:257-67. [PMID: 17216380 DOI: 10.1007/s00270-005-0309-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Using a pig model: (1) to evaluate the vascular distribution pattern, including the homogeneity and completeness of the intra-arterial microsphere distribution, of 40-120-microm trisacryl-gelatin microspheres (Embospheres) in acute whole-kidney embolization; (2) to evaluate the durability and biocompatibility of 40-120-microm trisacryl-gelatin microspheres (Embospheres) in chronic partial kidney embolization. METHODS Twenty-two animals were divided into four groups: group 1 (n = 4) underwent total arterial renal occlusion with immediate euthanasia. Groups 2-4 had chronic superselective and partial renal embolization with increasing follow-up times: group 2 (n = 2), 1 week; group 3 (n = 7), 4 weeks; and group 4 (n = 9), 14 weeks. Key endpoints in group 1 were homogeneity and completeness of acute embolizations. In groups 2-4 the key endpoints were durability of embolization and particle-related inflammation in chronic partial embolizations as assessed by quantitative angiography or histomorphometry. A numerical angiographic occlusion score (0.0 to 4.0, where 3.0 is optimal) was developed to assess and quantify the angiographic durability of superselective embolizations (groups 2-4). RESULTS In group 1, a relatively homogeneous distribution of the particles from segmental arteries to the precapillary level was shown by histomorphometry. Some particles reached the glomerular vas afferens (10 microm diameter). In groups 2-4, a mild recanalization appeared during follow-up. The immediate average postembolization occlusion score of 3.18 +/- 0.73 was reduced to 1.44 +/- 0.73 (statistically significant). Microscopy revealed subtotal necrosis but no foreign body granuloma formation. The intra-arterial appearance of giant cells closely attaching to the surface of the embolic spheres inside the vessel lumen was noted. Vessel walls showed major ischemic reactions. CONCLUSION Microspheres 40-120 microm in diameter might achieve total occlusion of the arterial kidney vasculature when injected centrally as a result of their fairly homogeneous distribution. Segmental renal infarction occurs after chronic partial embolization despite recanalizations during follow-up. Only mild specific intra-arterial foreign body reactions were found.
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Preoperative embolization of a tumor-bearing horseshoe kidney via both channels of a concomitant aortic dissection. Cardiovasc Intervent Radiol 2007; 30:501-3. [PMID: 17206388 DOI: 10.1007/s00270-006-0268-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Renal cell carcinoma arising in a horseshoe kidney is a rare entity. Preoperative tumor embolization can be performed to prevent massive bleeding complications during organ-preserving surgery. We report the first case of a patient with a tumor-bearing horseshoe-kidney in whom the preoperative embolization, already complex because of the abnormal vascular supply, was additionally complicated by an aortic dissection. An aberrant, horseshoe-kidney-supplying artery originated from the false dissection channel of the aorta, and thus had to be catheterized separately while the other tumor-supplying vessels could be reached via the true aortic lumen. After devascularization of the tumor, organ-preserving surgery was performed without bleeding complications.
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Differentialdiagnostik renaler Raumforderungen. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-976595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Eine radiologische Fallsammlung mit interaktivem und multimedialem Charakter als neues Element in der studentischen Ausbildung. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Vergleich der In-Stent Stenose und der Entzündung der Gefäßwand nach Einsatz des Cypher Select, des Taxus Express und eines mit Polyzene-F Nanocoated Cobalt-Chrom Stents im Koronararterien-Modell. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Das intravertebrale Vakuumphänomen als spezifisches Zeichen einer Osteonekrose – Radiologischer und histologischer Vergleich bei Wirbelfrakturen. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pneumatosis intestinalis und portomesenterische Gasansammlung – Genese und Prognoseabschätzung mittels CT-morphologischer Kriterien. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-976796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Histopathologische Korrelation des late enhancements bei cardialer Amyloidose. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-976824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Immunhistochemische Quantifizierung der Entzündungsreaktion von beschichteten und unbeschichteten Gefäßstents. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Technischer Erfolg der Monorail-Stentimplantation in Nierenarterien. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Verbesserung des Überlebens bei Patienten nach Lebertransplantation mit einer akuten Cholangitis mittels des Einsatz einer selektiven Gallengangsspübehandlung. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Entzündungsreaktion und Rekanalisation nach Embolisation mit den sphärischen Embolisaten EmbozeneTM, Embosphere, Bead BlockTM und Contour im Mini-Pig Nierenmodell. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ist das Knochenmarködem frischer Frakturen im MRT ein Garant für einen guten Langzeiteffekt der Kyphoplastie: 1 Jahresvergleich alter und frischer osteoporotischer Wirbelkörperfrakturen. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-976885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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PMMA im Vergleich zu Calcibon in der Behandlung schmerzhaften osteoporotischer Wirbelkörperfrakturen: 3 Jahres-Verlauf einer prospektiven Studie. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-976888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ergebnisse der portalen Embolisation vor geplanter Leberresektion bei einem zu erwartenden Leberrestvolumen von <25%. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-976876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Staging der zystischen Echinokokkose – Bedeutung des Zystenkalks. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-976798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Einfluss von Stentmaterial und Strebendicke auf Artefakte und Beurteilbarkeit einer simulierten Restenose im 16 Zeilen MDCT. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-976896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ganzkörper-MRT im Vergleich zum Röntgen-Skelettstatus bei Patienten mit neu diagnostiziertem multiplem Myelom: Einfluss auf Staging und Therapieindikation. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
BACKGROUND Experience of just under 5 years has shown that balloon kyphoplasty can be just as successfully employed as the longer-stablished vertebroplasty for the treatment of back pain due to recent or prior osteoporotic fractures as well as new traumatic fractures. MATERIAL AND METHOD Among 345 patients with a total of 690 treated vertebral bodies, the change in pain symptomatology was analyzed for a follow-up period of 12 months in 40 study patients who underwent kyphoplasty and a control group of 20 patients. In addition, the pain experienced by a further 29 patients with new traumatic vertebral body fractures was monitored over a 12-month period. These fractures were partly managed by fixateur interne alone and by a combination of fixateur interne and kyphoplasty. RESULTS The 40 patients treated by kyphoplasty had a baseline VAS score of 26.2+/-2.00, which increased to 44.4+/-3.11 after 12 months, while the respective scores for the control group were 33.6+/-4.21 and 34.3+/-4.35. In the 29 patients with new traumatic vertebral body fractures, the initial VAS score was 62 and after 12 months a distinct reduction of pain was noted with a score of 20 (100 = maximum pain, 0 = no pain). The number of times that the 40 patients managed by kyphoplasty had to consult their general practitioner was significantly reduced by the pain therapy. CONCLUSION Balloon kyphoplasty verifiably improved the pain symptomatology after vertebral fracture over a period of 12 months. Comparison with the control group, which received the same osteoporosis drug therapy, confirmed the effect of this minimally invasive treatment form.
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Prof. Dr. Werner Wenz zum 80. Geburtstag. Radiologe 2006; 46:613-4. [PMID: 16816971 DOI: 10.1007/s00117-006-1393-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Comparison of CT During Arterial Portography and MR During Arterial Portography in the Detection of Liver Metastases. AJR Am J Roentgenol 2006; 186:1502-11. [PMID: 16714637 DOI: 10.2214/ajr.05.0879] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study compared MR during arterial portography (MRAP) with CT during arterial portography (CTAP) with regard to the detection and differentiation of liver metastases before surgery. MATERIALS AND METHODS Fifteen patients with liver metastases were enrolled before surgery according to the guidelines of our institutional review board and good clinical practice. After mesentericography, unenhanced scans (Volume Zoom) were performed initially. For CTAP, the contrast medium was injected through the superior mesenteric artery. Images were acquired in portal and delayed enhancement. The MR protocol (1.5 T; Magnetom Symphony) started with T1-weighted fast low-angle shot (FLASH) T2-weighted turbo spin echo (TSE). MRAP followed with gadolinium-enhanced dynamic T1-weighted 3D FLASH. Delayed-phase T1-weighted 2D FLASH axial images were performed 2 min after IV injection of the contrast medium. Qualitative and quantitative evaluation of CTAP and MRAP was performed by three blinded radiologists regarding the number of lesions and their size, localization, and differential diagnosis. RESULTS The overall sensitivity in detecting liver metastases was 97% with MRAP and 93% with CTAP (p > 0.05, not significant [n.s.]). The specificity was calculated to be 97% for MRAP and 82% for CTAP (p < 0.0001, statistically significant [s.s.]). The differences in sensitivity were more accentuated if only lesions 10 mm or smaller were considered (95% vs 88%, p > 0.05, n.s.), for which the respective specificities were 95% and 80% (p < 0.0014, s.s.). Improvements in sensitivity and specificity were associated with a higher lesion-to-liver contrast-to-noise ratio (59.4 +/- 51.0 for MRAP vs 10.4 +/- 7.3 for CTAP) and resulted in higher diagnostic confidence in the differential diagnosis of liver lesions (p < 0.001, s.s.) and better interobserver agreement (median kappa value, 0.88 vs 0.63). CONCLUSION MRAP proved to be a reliable method in the preoperative detection of small liver metastases in particular, with a higher sensitivity and specificity than CTAP. If organizational difficulties of MRAP can be overcome, MRAP could be considered instead of CTAP in the preoperative invasive evaluation of metastatic liver disease.
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New coil concept for endoluminal MR imaging: initial results in staging of gastric carcinoma in correlation with histopathology. Eur Radiol 2006; 16:2401-9. [PMID: 16733675 PMCID: PMC1705470 DOI: 10.1007/s00330-006-0318-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Revised: 04/03/2006] [Accepted: 04/25/2006] [Indexed: 12/20/2022]
Abstract
Our aim was to conduct a prospective study to evaluate staging accuracy of a new coil concept for endoluminal magnetic resonance imaging (MRI) on ex vivo gastric carcinomas. Twenty-eight consecutive patients referred to surgery with a clinically proven primary gastric malignancy were included. Surgical specimens were examined with a foldable and self-expanding loop coil (8-cm diameter) at 1.5 Tesla immediately after total gastrectomy. T1- and T2-weighted and opposed-phase sequences (axial, frontal sections; 3- to 4-mm slice thickness) were acquired. Investigators blinded to any patient information analyzed signal intensity of normal gastric wall, gastric tumor, and lymph nodes. Findings were compared with histopathological staging. On surgical specimens, 2-5 gastric wall layers could be visualized. All gastric tumors (26 carcinomas, two lymphomas) were identified on endoluminal MR data (100%). Overall accuracy for T staging was 75% (18/24); sensitivity to detect serosal involvement was 80% and specificity 89%. N staging correlated in 58% (14/24) with histopathology (N+ versus N-). The endoluminal coil concept is feasible and applicable for an ex vivo setting. Endoluminal MR data provided sufficient detail for gastric wall layer differentiation, and therefore, identification of T stages in gastric carcinoma is possible. Further investigations in in vivo settings should explore the potential of our coil concept for endoluminal MR imaging.
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Abstract
Due to their potential for serious consequences, even including biliary liver cirrhosis, benign biliary strictures pose a considerable diagnostic and therapeutic challenge. In addition to inflammatory disease or an acute liver injury, iatrogenically caused biliary strictures following hepatobiliary surgery represent in 95% of cases the main cause for all benign entities. The diagnosis should be determined noninvasively with magnetic resonance cholangiopancreaticography (MRCP). Invasive techniques such as ERCP or percutaneous transhepatic cholangiography (PTC) should be reserved for unclear cases and first performed before the scheduled intervention. Depending on the site and cause of the stricture, surgical and interventional procedures are employed in the treatment of biliary strictures. The best results are obtained in short-segment strictures of the main bile duct. Interventional methods such as balloon dilation and/or stent application with concomitant drain insertion achieve patency rates of up to 75% after 5 and 55% after 12 years with a total complication rate of 5-8%. Due to the fact that most of the cases involve cicatricial fibroses, predisposition for recurrence of biliary strictures after interventional therapy can be very high, ranging up to 66% depending on the localization.
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Präoperative und palliative Embolisation des Nierenzellkarzinoms: Nachsorge von 49 Patienten. ROFO-FORTSCHR RONTG 2006; 178:391-9. [PMID: 16612730 DOI: 10.1055/s-2006-926538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the influence of preoperative and palliative embolization of renal cell carcinomas on survival, intra- and post-operative procedures, and symptom control for palliative and preoperative indications. MATERIALS AND METHODS 56 patients who underwent renal cell carcinoma embolization from 1981 to 1999 were included in this retrospective study. RESULTS 24 women and 32 men were included (mean age 59.4 years). Complete follow-up data was available for 49 patients. 42 patients underwent preoperative embolization at different tumor stages (pT1: 1 patient, pT2: 6, pT3 a: 4, pT3 b: 19, pT3 c: 2, pT4: 5). 14 patients underwent palliative embolization (T1: 0 patients, T2: 5, T3: 4, T4: 4). Indications for preoperative embolization were bleeding of the renal tumor in 6 cases -- non-recurrent bleeding reported, flank pain in 4 patients -- 3 of 4 patients had no further symptoms, recurrent tumor embolization in 1 patient, and 2 patients who wanted to be treated without symptoms. The mean survival time of preoperative embolized patients was 3.1 +/- 5.11 years with a 5-year survival rate of 50 %. The mean survival time of palliative embolized patients was 0.67 +/- 0.76 years with initial metastases (n = 7) and 2.33 +/- 2.40 without metastases (n = 6). CONCLUSION Palliative embolization of renal cell carcinomas is a safe therapeutic method to treat advanced renal cell carcinomas allowing control of symptoms such as hematuria and flank pain in more than 90 % of our cases. Preoperative embolization yields a patient survival time comparable to that of patients at earlier tumor stages and is dependent on the metastases.
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Atypical manifestations of multiple myeloma: radiological appearance. Eur J Radiol 2006; 58:280-5. [PMID: 16431064 DOI: 10.1016/j.ejrad.2005.11.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2005] [Revised: 11/22/2005] [Accepted: 11/23/2005] [Indexed: 11/26/2022]
Abstract
Diagnostic procedures performed on patients with multiple myeloma typically reveal lytic bone lesions, osteopenia or osteoporosis, bone marrow infiltration by plasma cells as well as overproduction of immunoglobulin or light chains in the serum or urine. Skeletal manifestations are extremely variable and the unusual forms have been described extensively. Extramedullary plasma-cell tumours (plasmocytoma) are found in about 5% of newly diagnosed patients with multiple myelomas. In this paper we present eight patients with atypical forms of multiple myeloma.
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Transarterial embolization of primary and secondary tumors of the skeletal system. Eur J Radiol 2006; 58:68-75. [PMID: 16413155 DOI: 10.1016/j.ejrad.2005.12.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2005] [Revised: 11/28/2005] [Accepted: 12/01/2005] [Indexed: 12/15/2022]
Abstract
Percutaneous transcatheteral embolizations of primary and secondary bone tumors are important minimal invasive angiographic interventions of the skeletal system. In most of the cases embolization is performed for preoperative devascularization or as a palliative measure to treat tumor-associated pain or other tumor bulk symptoms. The transarterial embolization of primary and secondary tumors of the skeletal system has been developed to a safe and very effective method. Indications, techniques, results and complications of this minimal invasive interventional therapy for treatment of primary and secondary bone tumors are described and discussed and compared with the newer literature and our own results.
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Ganzkörper-MRT bei Patienten mit Multiplem Myelom nach Stammzelltransplantation. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Einflüsse von Designfaktoren von Stents: was verhindert die Restenose mehr? ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Diagnostik der Nieren mit der Multislice-CT und MRT: Neue Entwicklungen in der Bildgebung. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Embolisation von primären und sekundären Tumoren des Skelettsystems: technische und klinische Erfolge. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Inzidenz und Risikofaktoren einer akuten Pankreatitis nach TACE. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Evaluation der Eigenschaften der Oberflächenbeschichtung PTFEP anhand eines selbstexpandierenden NiTinolstents im Nierenarterienmodell am Minipig. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dynamische kontrastverstärkte MRT zur beim M. Paget des Knochens: Vergleich von Mikrozirkulation und Stoffwechselaktivität unter Bisphosphonattherapie. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Erhöhung der T1-Relaxationszeit bei kardialer Amyloidose – Erweiterung des Spektrums morphologischer und funktioneller Kriterien bei der MRT des Herzens. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Spezifische morphologische Verhaltensmuster submuköser Myome nach Embolisation im Mittelfristverlauf (>2 Jahre). ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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